BACKGROUND:The high incidence of in-stent restenosis (ISR) associated with bare-metal stents (BMS) undermines the viability of endovascular treatment as a treatment option for patients with severe symptomatic intracranial atherosclerotic stenosis (ICAS). The study aimed to evaluate whether durable fluoropolymer drug-eluting stents (DES) reduce the incidence of ISR compared with BMS in the treatment of severe ICAS. METHODS:This prospective, multicentre, open-label, blinded outcome clinical trial was conducted at 16 centres in China, enrolling patients with ischaemic stroke or transient ischaemic attack (<90 days) attributed to 70%-99% stenosis of an intracranial major artery. Eligible patients were randomly assigned to receive durable fluoropolymer DES or BMS for stenosis treatment. The primary outcome was ISR at 1 year postprocedure, which was defined as a stenosis rate of ≥50% occurring within or immediately adjacent to (within 5 mm) the stent. Secondary outcomes included symptomatic ISR and stroke or death within 30 days or stroke in the target vessel territory between 31 days and 1 year. RESULTS:Between 20 February 2023 and 10 April 2024, 156 patients were enrolled and assigned to receive DES (n=78) or BMS (n=78). The median age was 61 years (IQR 54-67), and 129 (82.7%) of 156 patients were male. At 1 year, the primary outcome occurred in 2.9% in the DES group versus 27.9% in the BMS group (risk difference -0.25, 95% CI -0.37 to -0.13, p<0.001). No significant differences were observed between the DES and BMS groups in symptomatic ISR (0% vs 2.9%, p=0.20) or in stroke or death within 30 days or stroke in the target vessel territory between 31 days and 1 year (7.7% vs 12.3%, p=0.45). CONCLUSIONS:Among patients with severe ICAS, treatment with durable fluoropolymer DES resulted in a lower 1-year ISR compared with BMS. TRIAL REGISTRATION NUMBER:NCT05719883.

BACKGROUND:Although the neuroprotective potential of remote ischemic postconditioning (RIPC) has been reported, the efficacy and safety of ultra-early RIPC administered after endovascular treatment (EVT) in patients with acute ischemic stroke remain unclear. This study evaluated the efficacy and safety of ultra-early RIPC in patients with acute ischemic stroke undergoing EVT. METHODS:The EnTRIPS trial (Endovascular Treatment Combined With Remote Ischemic Postconditioning in Patients With Acute Ischemic Stroke) was a multicenter, randomized, controlled, outcome assessor-blinded, prospective clinical trial. The trial was conducted at 8 hospitals in China between April 12, 2021, and March 26, 2025. Eligible patients were adults with acute ischemic stroke due to large vessel occlusion who presented within 24 hours of symptom onset, underwent EVT, and achieved successful recanalization. A total of 270 eligible patients were randomized within 6 hours after EVT to receive either RIPC plus guideline-based therapy (n=135) or guideline-based therapy alone (n=135). RIPC was administered for 7 days using pneumatic devices consisting of 5 cycles of bilateral upper-arm cuff inflation (5 minutes at 180 mm Hg) followed by deflation (3 minutes). The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale score of 0 to 2 (range, 0 [no symptoms] to 6 [death]). Safety outcomes included the incidence of RIPC-related adverse events within 7 days. RESULTS:Among 270 randomized patients, a total of 268 (99.3%) participants completed the trial, including 133 in the RIPC group and 135 in the control group (mean [SD] age, 65.5 [16.8] years; 171 [63.8%] men). At 90 days, functional independence was achieved in 81 (60.9%) patients in the RIPC group and 78 (57.8%) patients in the control group (adjusted risk ratio, 1.07 [95% CI, 0.89-1.30]; P=0.46). RIPC-related adverse events occurred in 10 of 133 (7.5%) patients, and no intervention-related adverse events occurred in the control group. CONCLUSIONS:Ultra-early RIPC is safe for patients with acute ischemic stroke treated with EVT, but it does not significantly improve the 90-day functional outcomes. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT04581759.

Adiponectin (ADN) regulates DNA synthesis, cell apoptosis and cell cycle to participate in the pathology and progression of glioblastoma. The present study aimed to further explore the effect of ADN on temozolomide (TMZ) resistance in glioblastoma and the underlying mechanism of action. Glioblastoma cell lines (U251 and U87-MG cells) were treated with ADN and TMZ at different concentrations; subsequently, 3.0 µg/ml ADN and 1.0 mM TMZ were selected as the optimal concentrations for the experimental conditions. LY294002 (a PI3K inhibitor) was added to ADN or ADN + TMZ-treated glioblastoma cell lines. Cell growth rate was determined using the Cell Counting Kit-8 assay, the apoptotic rate and cell cycle were evaluated using Annexin V/propidium iodide and cell cycle assays, and p-Akt (Thr308), p-Akt (Ser473), Akt, p-mTOR, c-caspase 3, caspase 3, Bax, cyclin B1 and cyclin D1 expression was determined by western blotting. Adiponectin receptor (ADIPOR) 1 and ADIPOR2 were expressed in glioblastoma cell lines. The glioblastoma cell line growth rate was increased by ADN in a concentration- and time-dependent manner. ADN inhibited glioblastoma cell line apoptosis and facilitated cell cycle. Of note, ADN activated the Akt/mTOR pathway and the addition of LY294002 reversed the effect of ADN, indicating that ADN activated the Akt/mTOR pathway to suppress apoptosis and promote cell cycle in glioblastoma cell lines. Notably, TMZ inhibited glioblastoma cell line growth, promoted apoptosis and increased G2 phase cell cycle arrest. However, the addition of ADN reversed the effect of TMZ in glioblastoma cell lines, disclosing that ADN induced TMZ resistance. Markedly, ADN-mediated TMZ resistance was further attenuated by LY294002, suggesting that ADN activated the Akt/mTOR pathway to induce TMZ resistance in glioblastoma cell lines. In conclusion, ADN activated the Akt/mTOR pathway to facilitate cell cycle, inhibit cell apoptosis and induce TMZ resistance in glioblastoma.

The presence of early venous filling (EVF) post-mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients has been observed, yet its prognostic value for clinical outcomes remains underexplored. This study aimed to assess the correlation between EVF and poor clinical outcomes in AIS patients who underwent MT. This retrospective analysis included AIS patients with large vessel occlusions treated with MT at the First Affiliated Hospital of Xi’an Jiaotong University from January 2018 to June 2023. The primary outcome was mRS at 90 days, secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and malignant brain edema. The study used inverse probability weighting for balancing baseline characteristics and employed univariate and multivariate logistic regression analyses to explore the association between EVF and clinical outcomes. G*Power was used to calculate the sample size. Among 307 patients, 75 (24.4

Background: Endovascular thrombectomy (EVT) has improved both short-term and long-term outcomes for acute ischemic stroke (AIS) patients caused by large vessel occlusion (LVO). However, the relationships between blood pressure (BP) after EVT and outcomes had not been determined. As BP is dynamically changes, the present study investigated the effects of BP trajectories after EVT on the outcomes in AIS patients with LVO using Group-Based Trajectory Modeling (GBTM). Methods: This was a retrospective, single-center observational study. The AIS patients with LVO in the anterior circulation within 24 hours of symptom onset, baseline modified Rankin Scale (mRS) score ≤2, and Alberta Stroke Program Early CT Score (ASPECTS) score ≥6 were included. BP was monitored frequently post-EVT, and PP was calculated as the difference between systolic and diastolic BP. GBTM identified distinct PP trajectories over 0-6 hours and 0-48 hours post-EVT. Short-term outcomes included hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (SICH), while long-term outcomes included National Institutes of Health Stroke Scale (NIHSS) at 7 days and mRS score at 3 months. Results: Out of 506 screened patients, 313 were included in the final analysis. GBTM identified three distinct PP trajectories within the first 6 and 48 hours post-EVT. The 0–6 hour PP trajectory was significantly correlated with HT (OR=1.81, 95% CI 1.28-2.54), which remained significant after adjustment (OR = 1.72, 95% CI 1.17-2.53). An elevated PP trajectory was associated with a 3.04-fold higher risk of HT compared to the normal trajectory. Mediation analysis indicated the 7-day NIHSS score mediated 88.92% of the association between severe elevated PP trajectory and mRS. Conclusion: Severely elevated PP trajectory post-EVT is independently associated with poor short-term outcomes in AIS patients with LVO. Effective management of PP in the acute phase post-EVT may be crucial for improving prognosis of AIS patients with LVO.

The role of intra-arterial tenecteplase for acute large vessel occlusion (LVO) stroke after successful endovascular therapy is uncertain. To assess the efficacy and safety of intra-arterial tenecteplase in patients with successful endovascular therapy (defined as a score on the expanded Thrombolysis in Cerebral Infarction [eTICI] scale of 2b to 3) after endovascular therapy. This was a prospective, open-label, blinded end point, randomized trial. Recruitment took place between February 16, 2023, and March 23, 2024, with final follow-up on July 4, 2024. The study was conducted across 19 centers in China. Patients with acute anterior circulation LVO treated between 4.5 and 24 hours from the time that the patient was last known to be well were included. After successful endovascular recanalization, defined as eTICI 2b or greater, patients were randomized to receive intra-arterial tenecteplase at 0.125 mg/kg (n = 126) or standard medical treatment (n = 129). The primary end point was excellent outcome at 90 days, defined as modified Rankin Scale (mRS) score of 0 to 1 (range, 0 [no symptoms] to 6 [death]). There were a total of 7 secondary efficacy end points (mRS score of 0-1 at 90 days, mRS score at 90 days, mRS score of 0-2 at 90 days, mRS score of 0-3 at 90 days, National Institutes of Health Stroke Scale score of 0-1 or improved ≥10 points at 36 hours, European Quality of Life Visual Analogue Scale score at 90 days, time to maximum volume > 6 s at 24 hours, and infarct core volume change from baseline) and 3 safety end points, including symptomatic intracranial hemorrhage (sICH) within 48 hours, any intracranial hemorrhage within 48 hours, and all-cause mortality within 90 days. Among 256 patients who were randomized (median [IQR] age, 71.6 [61.3-79.2] years; 113 [44.1%] females), 255 (99.6%) completed the trial. The rate of patients with an mRS score of 0 to 1 at 90 days was 40.5% in the intra-arterial tenecteplase group (n = 51) and 26.4% in the standard medical treatment group (n = 34) (relative risk, 1.44 [95% CI, 1.06-1.95]; P = .02). Of 7 prespecified secondary efficacy end points, none showed a significant difference. Intra-arterial tenecteplase after endovascular therapy did not increase the incidence of sICH within 48 hours after treatment compared with standard medical treatment (5.6% vs 6.2%; relative risk, 0.95 [95% CI, 0.36-2.53]; P = .92). Mortality at 90 days was 21.4% with intra-arterial tenecteplase and 21.7% with standard medical treatment (relative risk, 0.76 [95% CI, 0.40-1.43]; P = .78). In patients with acute LVO presenting between 4.5 and 24 hours of symptom onset, intra-arterial tenecteplase after successful thrombectomy had a greater likelihood of excellent neurological outcome at 90 days without increasing the risk of sICH or mortality. However, because none of the secondary efficacy analyses supported the primary finding, further trials are needed to confirm the results. ClinicalTrials.gov Identifier: NCT05624190

Objective To investigate the efficacy and safety of tirofiban application during emergency endovascular treatment in patients with acute ischemic stroke due to large artery atherosclerosis (LAA). Methods A total of 326 patients diagnosed with acute ischemic stroke due to LAA and subjected to emergency endovascular treatment at The First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to June 2023 were enrolled. All patients underwent endovascular treatment and were divided into tirofiban group (n=183) and non-tirofiban group (n=143) based on intraoperative tirofiban application. The primary outcome was defined as the modified Rankin Scale (mRS) score of 0-2 (functional independence) at 90d postoperatively. Secondary outcomes were included mRS score of 0-1 (excellent prognosis) at 90d, the mRS score of 0-3 (favorable prognosis) at 90d, and modified Thrombolysis in Cerebral Infarction (mTICI)≥2b (successful recanalization). Security indicators were included the incidence of symptomatic intracranial hemorrhage (sICH) within 24h postoperatively, the incidence of intracranial hemorrhage (ICH) within 24h postoperatively, and the all-cause mortality at 90d postoperatively. Results Regarding the primary outcome, no statistically significant difference was observed between the 2 groups in the proportion of patients achieving the mRS score of 0-2 at 90d postoperatively (χ2=0.703, P=0.402). For secondary outcomes, there were no significant differences between the 2 groups in the following measures: mRS score of 0-1 at 90d postoperatively (χ2=0.359, P=0.549), mRS score of 0-3 at 90d postoperatively (χ2=2.513, P=0.113), mTICI≥2b postoperatively (χ2=0.763, P=0.384). In terms of security indicators, no statistically significant differences were observed between the 2 groups in the following: incidence of sICH (χ2=0.257, P=0.612), incidence of ICH (χ2=3.561, P=0.059) at 24h postperatively, all-cause mortality at 90d postoperatively (χ2=0.370, P=0.543). Logistic regression analysis showed that intraoperative tirofiban application was not an independent predictor of functional independence (mRS score of 0-2) at 90d postoperatively. Conclusions In patients with acute ischemic stroke due to LAA, the tirofiban application during emergency endovascular treatment did not significantly improve clinical outcomes. However, it was not associated with an increased risk of ICH or mortality.

INTRODUCTION:Intracranial atherosclerosis is the main cause of stroke globally, with acute large vessel occlusive (LVO) stroke being a predominant contributor to stroke-related mortality. In recent years, aspiration thrombectomy (AT) has emerged as a novel therapeutic method for treating acute LVO stroke. The purpose of this study aims to investigate the safety and efficacy of AT alone or combined with stent retriever thrombectomy (SRT) in the treatment of acute LVO stroke METHODS AND ANALYSIS: This is a multicentre and observational real-world study involving patients diagnosed with acute LVO stroke. Participants will be treated with AT alone or combined with SRT. According to the actual annual number of embolectomy in the sub-centre and the research years, the sample size of this study is estimated to be 400 patients, of which 300 patients of anterior circulation lesions and 100 patients of posterior circulation lesions are planned to be recruited, being considered that the incidence of posterior circulation is about 20-25%. Clinical data, including baseline characteristics, intraoperative details, postoperative outcomes and follow-up results, will be systematically collected using an Electronic Data Capture system over a follow-up period of 3 months. The primary efficacy endpoint is the rate of excellent functional outcome (modified Rankin Scale score range 0-3) after 90 days, and the successful recanalisation confirmed by digital subtraction angiography. The primary safety outcome is symptomatic intracranial haemorrhage within 48 hours (National Institutes of Health Stroke Scale score increase ≥4). This study will provide us with powerful guidance for the treatment of acute LVO stroke with different aetiologies. ETHICS AND DISSEMINATION:This study protocol was approved by the Ethics Committee on Human Experimentation at Shandong Provincial Hospital Affiliated to Shandong First Medical University (approval number: SWYX:2022-1025). All the participating sites have received the ethics approval. The outcomes will be disseminated through national and international presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER:ChiCTR2200065172.

BACKGROUND:Randomized studies have demonstrated the efficacy of endovascular therapy (EVT) for acute large vessel occlusion with large infarction. However, the impact of the occlusion site on EVT outcomes remains underexplored. METHODS:We conducted this prespecified subgroup analysis of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core (ANGEL-ASPECT) trial. Participants were enrolled within 24 h of symptom onset and had an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 or an infarct core volume of 70-100 mL and were randomly assigned to undergo EVT or standard medical management (MM). All 455 patients were included and categorized into 2 subgroups by whether there was an internal carotid artery occlusion (ICAO) or middle cerebral artery occlusion (MCAO). The primary outcome was functional outcome (modified Rankin Scale) at 90 days. We further assessed the association between onset-to-puncture time (OPT) and outcome in both groups using ordinal logistic regression and tested for an interaction between occlusion site and the effect of EVT. RESULTS:A total of 164 patients (36.0%) had ICAO, while 291 patients (64.0%) had MCAO. The baseline characteristics of patients treated with EVT and MM were comparable in either the ICAO or MCAO groups. EVT benefit was observed in both groups without significant heterogeneity (p for interaction = 0.891). A significant statistic interaction between occlusion site and treatment on any intracranial hemorrhage (ICH) within 48 h was observed (p for interaction = 0.002), with ICAO significantly increasing the risk of ICH compared to MCAO in patients undergoing EVT (ICAO: common OR, 6.34; 95% CI, 2.84-14.16; MCAO: common OR, 2.19; 95% CI, 1.56-3.09). However, the risk of symptomatic ICH was not increased significantly in both groups. For patients with ICAO, when OPT exceeds about 10 h and 10 min, the benefit of EVT compared to MM is not significant. CONCLUSIONS:Although both ICAO and MCAO patients with large infarction could benefit from EVT, EVT increased the risk of any ICH in ICAO patients without increasing the risk of sICH. Longer OPT was associated with poorer EVT efficacy in patients with ICAO.Data access statement:The data supporting the findings of this study are available from the corresponding author upon reasonable request.Registration: URL: https://www. CLINICALTRIALS:gov; Unique identifier: NCT04551664.

AIMS:To investigate the characteristics of hypoperfusion and structural impairment in patients with transient ischemic attack (TIA) or minor stroke (MS) with intracranial atherosclerotic stenosis (ICAS) and evaluate its impact on cognitive decline. METHODS:Cognitive function in 47 patients and 33 health controls (HC) was assessed using the Montreal Cognitive Assessment (MoCA) tool. Arterial spin labeling with two distinct postlabeling delays and 3D T1 imaging was conducted to assess cerebral blood flow (CBF), morphometric features, and asymmetry index (AI). RESULTS:Compared with HC, both the left and right involved patients showed reduced scores for total MoCA score. Comparisons of CBF with HC revealed that significant ischemic areas in patients were primarily localized to the perfusion territory of the middle cerebral artery in the affected hemisphere (p < 0.05, family-wise error [FWE] corrected). Despite morphometry abnormality being locally confined, AI exhibits more widespread alterations across a wider range of brain regions (both p < 0.05, FWE corrected). Both hypoperfusion and structural impairment were significantly associated with reduced MoCA score in left-involved patients, whereas only hypoperfusion showed a significant association in those with right-hemisphere involvement (p < 0.05, FWE corrected). Furthermore, the effect of ischemia on cognition was mediated by structural impairment and compensatory CBF simultaneously. CONCLUSION:These findings highlight that hypoperfusion and structural impairment are already concerning and jointly associated with cognitive impairment in MS/TIA patients with ICAS, emphasizing the need for early detection and intervention.

This study aimed to explore the regulatory effects and associated mechanisms of adiponectin on apoptosis and proliferation in the LN18 glioma cell line through the AMPK and Akt signaling pathways. Additionally, we sought to elucidate the impact of adiponectin on the chemosensitivity of the LN18 glioma cell line to temozolomide (TMZ). The proliferation rate of glioma cells treated with adiponectin was assessed using the cholecystokinin (CCK8) assay. The Western blot analysis was employed to assess the expression of p-Akt, p-AMPK, p-mTOR, cleaved caspase3, Bax, Cyclin D1, and Cyclin B1 following adiponectin treatment. Cell apoptosis was quantified using AnnexinV/PI flow cytometry, while changes in the cell cycle were detected using PI staining flow cytometry. The findings revealed that adiponectin upregulates p-AMPK expression and downregulates p-mTOR expression in the PTEN wild-type glioma cell line LN18, with no discernible effect on p-Akt expression. Moreover, adiponectin inhibits the proliferation rate of the PTEN wild-type glioma cell line LN18, enhances the expression of cleaved caspase3 and Bax, and significantly elevates the apoptosis rate, as evidenced by AnnexinV/PI flow cytometry. Adiponectin was observed to suppress the expression of Cyclin D1 and Cyclin B1, increase the number of cells in the G1 phase, and promote autophagy. Additionally, adiponectin augments the expression of Beclin1 and the ratio of LC3II/I in the PTEN wild-type glioma cell line LN18, while decreasing p62 expression. In conclusion, this study posits that adiponectin holds therapeutic promise for glioma treatment. Furthermore, adiponectin enhances the inhibitory effect of TMZ on the proliferation rate of LN18 cells when treated with 0.1 mM and 1 mM TMZ. These results collectively suggest that adiponectin impedes proliferation, encourages apoptosis and autophagy in the LN18 glioma cell line, and heightens its sensitivity to the chemotherapeutic drug TMZ.

ImportancePrevious randomized clinical trials did not demonstrate the superiority of endovascular stenting over aggressive medical management for patients with symptomatic intracranial atherosclerotic stenosis (sICAS). However, balloon angioplasty has not been investigated in a randomized clinical trial.ObjectiveTo determine whether balloon angioplasty plus aggressive medical management is superior to aggressive medical management alone for patients with sICAS.Design, Setting, and ParticipantsA randomized, open-label, blinded end point clinical trial at 31 centers across China. Eligible patients aged 35 to 80 years with sICAS defined as recent transient ischemic attack (<90 days) or ischemic stroke (14-90 days) before enrollment attributed to a 70% to 99% atherosclerotic stenosis of a major intracranial artery receiving treatment with at least 1 antithrombotic drug and/or standard risk factor management were recruited between November 8, 2018, and April 2, 2022 (final follow-up: April 3, 2023).InterventionsSubmaximal balloon angioplasty plus aggressive medical management (n = 249) or aggressive medical management alone (n = 252). Aggressive medical management included dual antiplatelet therapy for the first 90 days and risk factor control.Main Outcomes and MeasuresThe primary outcome was a composite of any stroke or death within 30 days after enrollment or after balloon angioplasty of the qualifying lesion or any ischemic stroke in the qualifying artery territory or revascularization of the qualifying artery after 30 days through 12 months after enrollment.ResultsAmong 512 randomized patients, 501 were confirmed eligible (mean age, 58.0 years; 158 [31.5%] women) and completed the trial. The incidence of the primary outcome was lower in the balloon angioplasty group than the medical management group (4.4% vs 13.5%; hazard ratio, 0.32 [95% CI, 0.16-0.63]; P < .001). The respective rates of any stroke or all-cause death within 30 days were 3.2% and 1.6%. Beyond 30 days through 1 year after enrollment, the rates of any ischemic stroke in the qualifying artery territory were 0.4% and 7.5%, respectively, and revascularization of the qualifying artery occurred in 1.2% and 8.3%, respectively. The rate of symptomatic intracranial hemorrhage in the balloon angioplasty and medical management groups was 1.2% and 0.4%, respectively. In the balloon angioplasty group, procedural complications occurred in 17.4% of patients and arterial dissection occurred in 14.5% of patients.Conclusions and RelevanceIn patients with sICAS, balloon angioplasty plus aggressive medical management, compared with aggressive medical management alone, statistically significantly lowered the risk of a composite outcome of any stroke or death within 30 days or an ischemic stroke or revascularization of the qualifying artery after 30 days through 12 months. The findings suggest that balloon angioplasty plus aggressive medical management may be an effective treatment for sICAS, although the risk of stroke or death within 30 days of balloon angioplasty should be considered in clinical practice.Trial RegistrationClinicalTrials.gov Identifier: NCT03703635

基于马斯洛层次需求理论,分析医务人员的需求.医务人员的需求具有多样化、层次化、交叉性、阶段性和多变性的特点.据此视角,可通过实行付出与收获相适应的薪酬管理制度,分类施策差异化管理,建立起良好的双向沟通管理机制,打造有温度有情怀的人文医院,提升医务人员满意度.

Objective The purpose of this study was to investigate vaccine effectiveness in relieving symptoms in patients with the SARS-CoV-2 delta (B.1.617.2) variant. Methods In this retrospective study, 31 patients did not receive any vaccine (non-vaccination, NV), 21 patients received 1-dose of inactivated vaccine (one-dose vaccination, OV), and 60 patients received at least 2-dose inactivated vaccine (two-dose vaccination, TV). The baseline data, clinical outcomes and vaccination information were collected and analyzed. Results Patients in the OV group were younger than those in the other two groups (p = 0.001), but there was no significant difference in any of the other baseline data among the three groups. The TV group showed higher IgG antibody levels and cycle threshold values of SARS-CoV-2 than the NV and OV groups (p < 0.01), and time to peak viral load was shorter in the TV group (3.5 +/- 2.3 d) than in the NV (4.8 +/- 2.8 d) and OV groups (4.8 +/- 2.9 d, p = 0.03). The patients in the TV group (18%) showed a higher recovery rate without drug therapy (p < 0.001). Viral clearance time and hospital stay were significantly shorter in the TV group than in the NV and OV groups (p < 0.01), and there were no significant differences in these parameters between the OV and NV groups, but IgG values were higher in the OV group (p = 0.025). No severe complications occurred in this study. Conclusions Our results suggest that 2-dose vaccination can reduce viral load and accelerate viral clearance in patients with the delta variant and enhance the protection afforded by IgG antibodies in vivo. Key Messages In this study, our results shows that two-dose vaccination can reduce viral loads and accelerate viral clearance, and two-dose vaccination enhance the protection of IgG antibodies in vivo; however, one-dose vaccination did not confer protective effectiveness.

卒中中心建设是对院内医疗资源的整合和再造,是提升区域内脑血管疾病救治水平的重要抓手,与国家健康中国建设纲要相契合,与提升人民幸福感息息相关.本文就陕西省卒中中心建设体系搭建体系和方法进行探索.陕西省通过发挥卫健系统组织部署力,制定目标、实施方案,拟定标准化急救体系并提供政策支持,依靠牵头医院指导引领力,下沉帮扶并制定建设指标,组织质控会议,提升同质化水平,发挥网络平台信息支持力,打造"干预-救治-随访"的全流程的信息系统,挖掘基层医院发展源动力,多方发力,四力融合,打造上下贯通,各级医院互相补充的卒中急救体系.通过卒中中心建设系统提升区域内脑血管疾病救治能力.

PurposeThe study aimed to explore the efficacy and safety of the Neuroform EZ stent in treating acute anterior circulation large artery occlusion.MethodsThe clinical data of 42 consecutive patients with acute anterior circulation large atherosclerotic occlusion who were treated with the Neuroform EZ stent from January 2018 to August 2019 in our stroke care center, including baseline characteristics, images, therapeutic condition, and follow-up data were retrospectively analyzed.ResultsThere were 42 mechanical thrombectomy (MT) failure cases of intracranial atherosclerotic stenosis with rescue Neuroform EZ stent implantation, of which 78.6% (33/42) had a good prognosis and 88.1% (37/42) showed no re-stenosis at follow-up. The average time from puncture to recanalization is 79.50 ± 14.19 min. The successful rate of intraoperative stent release is 97.6%, while there is one case of stent displacement, three cases of thrombus escape, and six cases of hemorrhage.ConclusionRescue therapy of the Neuroform EZ stent for acute anterior circulation large atherosclerotic occlusion can archive good short-term imaging and clinical results, while long-term follow-up is still needed to verify.

Background:Severe cerebral artery embolism is a rare complication of facial autologous fat injection. However, its incidence has markedly increased with the recent rise in facial cosmetic procedures.Case presentation:We report a 31-year-old Chinese woman who presented with unconsciousness 6 h after having undergone a facial autologous fat injection. A neurological examination revealed stupor, bilaterally diminished pupillary light reflexes, right-sided central facial palsy, and no reaction to pain stimulation of right limbs. Diffusion-weighted imaging displayed patchy hyperintense lesions in the left frontal, parietal, and temporal lobes. Magnetic resonance angiography demonstrated fat embolism in the left internal carotid artery, anterior cerebral artery, and middle cerebral artery. We immediately performed mechanical thrombectomy under sufficient preoperative preparations but failed to achieve complete recanalization. Pathological examination of the embolus confirmed the presence of adipocytes. Although we actively administered symptomatic and supportive treatments, the patient eventually died due to the progression of cerebral herniation and systemic infection.Conclusion:Due to the ineffectiveness of current treatment and the inferior prognosis, fat embolism, a severe complication of autologous fat graft, should draw the attention of both plastic surgeons and neurologists so that actions may be taken for both its prevention and treatment.

Solasonine (SS), the main active ingredient of Solanum nigrum L., has been reported to possess a variety of pharmacological properties. A recent study demonstrated a neuroprotective effect of SS in a mouse nerve injury model. However, its protective effects on cerebral ischemia/reperfusion injury (CIRI) remain to be elucidated. We investigated herein the in vitro and in vivo neuroprotective effects of SS. Primary hippocampal neurons were exposed to oxygen and glucose deprivation/reoxygenation (OGD/R) to construct an in vitro model while rats were treated with middle cerebral artery occlusion/reperfusion (MCAO/R) to establish an in vivo CIRI model. The results showed that SS reduced OGD/R-induced inflammatory responses of neurons by blocking secretion of TNF & alpha;, IL-1 & beta; and IL-6. Moreover, SS ameliorated OGD/R-induced oxidative stress in neurons by decreasing the level of ROS and MDA and increasing the activity of SOD and GPx. We also found that SS protected neurons from OGD/Rinduced apoptosis by down-regulating bax and cleaved caspase-3 and up-regulating bcl-2. The in vivo results revealed that SS administration reduced the infarct volume and alleviated the neurological deficit of MCAO/R rats as well as diminished neuronal damages in these rats. Our investigation on the underlying mechanisms indicated that the neuroprotective effect of SS on CIRI may be associated with the TLR4/MyD88/NF-& kappa;B and AMPK/Nrf2/HO-1 pathways. Taken together, these findings demonstrate that SS ameliorates CIRI via suppressing TLR4/MyD88/NF-& kappa;B pathway and activating AMPK/Nrf2/HO-1 pathway.

This cross-sectional study investigates the prevalence, incidence, and mortality rate of stroke in China in 2020 using data from a nationally representative sample of rural and urban populations. Key Points Question What was the burden of prevalence, incidence, and mortality rate of stroke in China? Findings In this cross-sectional study of 676394 participants aged 40 years and older, the estimated overall prevalence, incidence, and mortality rate of stroke in mainland China in 2020 were 2.6%, 505.2 per 100000 person-years, and 343.4 per 100000 person-years, respectively. The prevalence of stroke was higher in urban areas than rural areas, but the incidence rate and mortality rate of stroke were higher in rural areas than urban areas. Meaning These findings suggest that there may be an urban-rural disparity in the burden of stroke in China, and an improved stroke prevention strategy is needed. Importance roke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited. Objective To investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations. Design, Setting, and Participants This cross-sectional study was based on a nationally representative survey that included 676394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China. Main Outcomes and Measures Primary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases. Results The study included 676394 Chinese adults (395122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P=.02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100000 person-years; P<.001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100000 person-years; P<.001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32]). Conclusions and Relevance In a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.

目的 探讨颅内动脉狭窄、血压变异性与急性缺血性脑卒中(AIS)患者神经功能及预后的关系.方法回顾性分析2018 年1 月—2021 年1 月收治的AIS 152 例的临床资料.根据是否发生早期神经功能恶化(END)分为END组(n =45)和非END组(n =107).根据卒中发病后90d的预后情况分为预后良好组(n =60)和预后不良组(n =92).评估颅内动脉狭窄程度,监测24h动态血压,计算收缩压标准差(SSD)、舒张压标准差(DSD).分析影响患者预后的危险因素.结果 END组颅内动脉总狭窄率高于非END组,且END组颅内动脉狭窄程度更严重(P＜0.05,P＜0.01).END组24 h SSD、24 h DSD、日间SSD、日间DSD、夜间SSD、夜间DSD均高于非END组(P＜0.05,P＜0.01).END组杓型血压节律的比例低于非 END组,而非杓型血压节律的比例高于非 END组(P＜0.05,P＜0.01).颅内动脉中、重度狭窄及入院时美国国立卫生研究院卒中量表评分＞12 分、24 h SSD＞12 mmHg、发生END是导致AIS患者预后不良的危险因素,而杓型血压节律为保护性因素(P＜0.05,P＜0.01).结论 颅内动脉狭窄程度、血压变异性与AIS患者神经功能有关,且是预后的影响因素.